About the service: About the service: William Lench Court provides personal care to people in their own homes within the provider's housing scheme. At the time of the inspection they were supporting 30 people.

People’s experience of using this service:

What life is like for people using this service:

People continued to tell us they felt safe and well supported. Staff had a good understanding in how they protected people from harm, and recognised different types of abuse and how to report it. There were enough staff on duty to keep people safe and meet their needs. People’s medicines were managed in a safe way. Safe practice was carried out to reduce the risk of infection.

Staff received training that was appropriate to them in their role and supported them in providing care in the way people wanted. Staff spoke positively about the support they received. Staff worked with external healthcare professionals and followed their guidance and advice about how to support people

People told us that staff were kind and caring and treated them with dignity and respect. People had regular care staff who knew how they liked to be supported.

The provider had a system in place for responding to complaints. People knew who to contact if they had any concerns.

The provider had quality assurance systems in place, however they were not fully effective as they had failed to identify some areas requiring improvements. The provider continued to promote an open and honest culture and people told us they were happy with the care they received.

More information is in Detailed Findings below.

Rating at last inspection: Good (report published May 2017).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will ask the provider following this report being published to tell us how they will make changes to ensure they improve the rating of the service to at least Good. We will revisit the service in the future to check if improvements have been made.

Enforcement:

No enforcement action was required.

We carried out an announced comprehensive inspection of this service on 7 July 2016. During that inspection we found that although the provider was not breaching any regulations the service required improvement. This was because we had concerns about how staff were supported to manage the risks associated with people’s conditions, how staff were deployed to support people in line with their care plans and how the quality of the service was monitored and improved upon. As a result we undertook a focused inspection to check whether the provider had made those improvements. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection in July 2016, by selecting the 'all reports' link for William Lench Court on our website at www.cqc.org.uk.

This focused inspection took place on 26 April 2017 and was announced. We gave 48 hours’ notice of our inspection to ensure that staff were available to provide the information we needed and we could make arrangements to speak with people who use the service.

William Lench Court provides personal care to 28 people in their own homes within the provider’s housing scheme. At the time of the visit the service had a registered manager although they had stopped working at the service in February 2017. We were accompanied during our inspection by the new manager who had worked at the service since February 2017 and was in the process of applying to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider had not ensured that systems to monitor the quality of the service had been sustained prior to the registered manager’s departure in February 2017. However the new manager and team leader were taking action to address this issue and had reintroduced some quality monitoring systems to the service. Insufficient checks had not enabled the provider to regularly monitor the quality of the service.

All the people we spoke with told us they were pleased with the support they received and some people told us that they felt the service had improved. Staff told us that the manager and team leader were supportive and led the staff team well. The manager was aware of their responsibilities to the commission and could explain the principles of promoting an open and transparent culture in line with their required duty of candour.

People told us that they felt safe using the service. Staff demonstrated that they were aware of the action to take should they suspect that someone was being abused. The manager had assessed and recorded the risks associated with people’s medical conditions and environments. The manager was supported by the provider’s human resources department to ensure staff were suitable to support people who used the service.

The manager had taken action to ensure people were supported by sufficient numbers of staff who knew them and could promptly respond to their needs. Medicines were administered safely by staff who were trained to do so. There was a training programme to refresh staff knowledge about how to meet people’s specific care needs.

People told us they were regularly involved in commenting on how their care was to be delivered and choosing how they wanted to be supported. People were supported in line with the Mental Capacity Act 2005.

There were processes in place if needed to monitor and improve people’s health when they were felt to be at risk of malnutrition. There were clear records of communications with other health and social care professionals when people’s conditions changed to ensure their health needs were met.

This inspection took place on 7 July 2016 and was announced. At our last inspection on 10 and 11 September 2015 we identified several concerns with the service. These included protecting people from the risks associated with their conditions, seeking consent in line with current legislation, staff deployment, quality monitoring and record keeping. After our inspection the provider sent us an action plan about how they intended to respond to our concerns. At our latest inspection we noted that the provider had taken action to address our concerns but further improvement was still required.

The service provides domiciliary care to 35 people in their own homes within the provider’s housing scheme. There was a registered manager at this location who was present during our visit. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

All of the people we spoke with told us that they felt the service kept them safe. Staff were encouraged to raise any concerns they might have about a person’s welfare and there was clear guidance for staff to follow if they felt someone was at risk of harm.

Although staff were knowledgeable about how to keep people safe from the risks associated with their specific conditions this information was not detailed in people’s care records. The provider had an effective system to check that staff were suitable to support people who used the service.

There were enough staff to meet people’s care needs. The service had experienced some staff turnover and a reliance on agency staff which regular staff said had made them very busy. The registered manager had taken action to ensure four new care staff would shortly start working at the service.

Staff we spoke to were confident in how to support people to take their medicines safely. The senior managers reviewed people’s medicines to ensure people had received their medicines as prescribed.

Staff had the skills and knowledge they required to meet people’s needs. Staff received ongoing training in relation to topics such as safeguarding, medication, health and safety and first aid.

Staff we spoke with knew and understood how people liked to be supported and people’s conditions were regularly discussed with care staff. Several people raised concerns with the knowledge of agency staff who occasionally supported them.

Staff sought consent before supporting people. The provider had taken action to ensure that people who may lack mental capacity would be supported by other people who had the legal right to make decisions on their behalf.

People were supported to eat and drink enough to keep them well and other professionals such as nutritionists were involved when staff were concerned with a person’s diet.

People told us that staff had supported them to access healthcare services when necessary. The registered manager had also developed a quick reference sheet for use by other health professionals should they need to support anyone who became unwell.

People were generally supported by regular staff and this had enabled them to develop positive relationships and express how they wanted their care to be delivered. The service promoted people’s privacy and dignity.

Staff responded promptly to people’s requests for support. People were given details of the formal complaints process when they started to use the service.

People described an open culture where they felt they could raise and safely discuss issues which could impact on their well-being. Care staff had supervisions and meetings to identify how the service could be developed to improve the care people received. Several members of staff said they felt that several concerns they had raised about the service hadn’t been listen

The inspection took place on 10 and 11 September 2015 and was announced. The service had not been inspected before.

The service provided domiciliary care to 26 people who lived in their own homes within the provider’s housing scheme. At the time of our inspection two people who used the service were in hospital.

There was a registered manager in place. The registered manager we spoke to during the inspection had been in their role for about two months. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Care staff were aware of people’s needs and how to keep them safe. Whilst staff knew how to support people, care plans lacked guidance about how to meet people’s conditions as they changed. People were at risk if receiving inconsistent care or care that failed to address known risks to people to keep them safe from harm. You can see what action we told the provider to take at the back of the full version of the report.

People were supported by the number of staff identified as necessary in their care plans and were usually supported by staff who were familiar to them. People felt staff were considerate and respectful of their wishes and feelings. However several people said that a lack of consistent staffing had prevented some of them from getting to know staff as well as they would like.

The provider was unable to demonstrate their processes to identify and review the numbers of and deployment of staff to meet people’s care needs or robust made arrangements to ensure staff attended calls on time.

The provider had conducted the appropriate character checks when new staff joined the service to ensure they were suitable to support the people who used the service. They were unable to demonstrate they always followed up gaps in people’s employment histories.

Care staff sought permission before providing care. When required people were supported to take their medication however the provider locked away people’s medicines so they could only be accessed by care staff. They had not assessed if people had the mental capacity to manage their own medicines safely or if less restrictive alternatives were available. The provider had not conducted assessments to protect peoples legal rights or identified if other people had authority to make decisions on behalf of people who used the service. You can see what action we told the provider to take at the back of the full version of the report.

Staff had the skills and knowledge to ensure people were supported in line with their care needs and best practice. People who required assistance to eat and drink were supported by staff but records of what people had eaten were not robust. Therefore it was not possible to review if people had eaten enough to keep them well.

People felt concerns would be sorted out quickly by care staff without the need to resort to the provider’s formal process. Investigations into formal complaints were conducted when necessary.

The provider had no formal process to engage and conduct reviews with people about their care plans. There was no effective process for staff to express their views of the service or discuss how the care people received could be improved. People had only limited opportunities in how they could influence and develop the service.

Staffing structures did not support care staff to be clear about their roles and responsibilities and what was expected of them. The provider had not ensured there was clear guidance to staff about how they should respond to ad-hoc requests for support outside of people’s agreed call times.

The provider did not have robust processes for monitoring and improving the quality of the care people received. The provider had identified several concerns with the quality of the service but had not developed plans to address these in order to keep people safe. You can see what action we told the provider to take at the back of the full version of the report.